AbstractsMedical & Health Science

As health care resources are limited, it is crucial to identify potential subgroups of patients with different resource needs and the major cost drivers in order to improve understanding of the cost structure of diabetes care. About one-third of the patients with type 1 diabetes develop diabetic nephropathy (DN), which is the most burdensome diabetic complication and the leading cause of end-stage renal disease (ESRD), requiring dialysis or kidney transplantation. Pharmaceutical interventions play an important role not only in controlling glycaemia, but also in preventing and treating related co-morbidities. The aim was to evaluate the use and costs of prescription medication in a large nationwide cohort of patients with type 1 diabetes, stratified by severity stages of diabetic kidney disease, and to study to what extent target values of the American Diabetes Association (ADA) guidelines were met in normal clinical settings and how achievement of the most relevant targets predicts the prognosis of the patients. All sub-studies are part of the ongoing, multicentre Finnish Diabetic Nephropathy Study (FinnDiane). Studies I (N=3,717), II (N=1,905), III (N=330) and V (N=3,151) have longitudinal and Study IV (N=3,678) a cross-sectional design. To obtain information on purchases of prescription medications, co-morbidities and mortality, the FinnDiane data were linked with several national registers. In patients with ESRD, the 11-year cumulative costs increased fourfold or even 15-fold, when diabetes medications were excluded compared to those without severe complications. The cost of diabetes medications remained quite stable irrespective of the presence of complications and duration of diabetes. The costs were significantly higher in patients with macroalbuminuria than in those with earlier stages of DN, and the gap continued to increase until the end of follow-up. A large gap exists between evidence-based guidelines and clinical practice since only a minority of all patients reached the targets for HbA1C, blood pressure (BP) and LDL cholesterol proposed by the ADA. Failure to reach the targets was associated with increased risk of cardiovascular disease and mortality. One of the novel findings was the high prevalence of treatment-resistant hypertension (RH) which increased in parallel with the worsening of DN in patients with type 1 diabetes. Progression to a more severe stage of DN has a substantial impact on prescription medication costs, highlighting the importance of early intervention to prevent or delay the onset of diabetic kidney disease. The treatment targets of HbA1C, BP and LDL cholesterol have not been achieved. Successful implementation of these targets would be a key for the optimal prevention of CVD and mortality. Diabetes aiheuttaa merkittäviä yhteiskunnallisia kustannuksia. Koska terveydenhuollon voimavarat ovat rajalliset, niiden tehokkaaksi kohdentamiseksi on tärkeää ymmärtää, mistä diabeteksen kustannukset aiheutuvat. Noin kolmasosa tyypin 1 diabetesta sairastavista kehittää diabeettisen…